Independent Lab Billing for TC of Pathology Services for Hospital Patients

Effective January 03, 2005 CR 3467 extends the provision of Section 542 of Benefits Improvement Protection Act of 2000 (BIPA) for services furnished in 2005 and 2006. Section 542 of BIPA allows the carrier to continue to pay independent laboratories under the physician fee schedule for the technical component of physician pathology services furnished to patients of a covered hospital.

Section 542 of BIPA provided that Medicare carriers could continue to pay for the TC of physician pathology services when an independent laboratory furnishes this service to an inpatient or outpatient of a covered hospital during 2001 and 2002. For this provision, covered hospital means a hospital that had an arrangement with an independent laboratory that was in effect as of July 22, 1999. The carrier will require independent laboratories that had an arrangement on or prior to July 22, 1999 with a covered hospital to bill for these services to provide a copy of this agreement or other documentation substantiating that an arrangement was in effect between the hospital and independent laboratory as of that date in order to pay the claim. This CR extends the provision for services provided during 2005 and 2006.